'I hear first-hand stories of the evacuees’

In 2008 – when I was just 13 years old and living in Mumbai – there was a devastating terrorist attack. It started on 26th November 2008 and lasted for four days. Those four days felt like the longest days of my life. My school was closed, and essential services were completely shut down. There was so much uncertainty. My father worked in the major business hub of Mumbai, and he couldn't return home until the shootings and explosions had completely stopped and the situation was under control.

This incident was one of many first-hand experiences of what it is like to witness the troops of an enemy occupy your homeland. You lose all your freedom. I couldn't help but think back to the events of 26/11 when, in the summer of 2021, the Taliban seized Afghan territory from the government following the withdrawal of the United States military. This Taliban takeover propelled Afghanistan into a humanitarian crisis, with millions of Afghans facing severe food insecurity due to lost income, cash shortages, and rising food costs.

The Afghan people were surely thinking – like I was in 2008 – that this might be the last time they would see their closed ones.

I have since moved to a western country to pursue a career in psychology. Now, working as part of the NHS – especially in a big city like London – I have a platform to be involved with different organisations that welcome refugees, many of which come from Afghanistan.

At the start of the latest war in Afghanistan, I reached out to several organisations to provide mental health support. I quickly realised that there was complete chaos in terms of the set-up of the various services at hand. One organisation that I interviewed for refused to take me on because I did not speak the official languages of Afghanistan (Dari or Pashto) – overlooking the opportunity to recruit a mental health professional with passion, drive and motivation.

Working as an Assistant Psychologist in the NHS, I often heard from colleagues working at Heathrow Airport who were helping to support the refugee crisis. In December 2021, I saw an advert in my trust's newsletter looking for mental health professionals interested in conducting wellbeing check-ins with Afghan evacuees. I quickly emailed the program lead, Dr Jai Adhyaru from the Centre for Anxiety, Stress & Trauma (CAST) within the Central & North West London NHS Foundation Trust, and started working for them shortly after.

Working in a Humanitarian Crisis Service

My initial weeks working on the project were spent learning and understanding the plans that the UK has put in place to tackle this humanitarian crisis. The UK government temporarily placed Afghan families in bridge hotels in the London boroughs of Kensington and Chelsea, and so I began working at these hotels to do introductory screenings with the refugees.

The purpose of these screenings was to establish some form of health record in the UK for the refugees. Due to the nature of their evacuation from Afghanistan, many had lost medical documentation and important information that would cause them to have significant difficulty accessing health services in the UK.

The screenings were done in pairs, usually two professionals if the refugee could speak English, or quite often, one professional alongside one interpreter (there were interpreters in various Afghan languages available on site to prevent any language barriers). The structure of the screenings consisted of collecting demographic information and conducting health questionnaires, before ending with trauma screening.

The first half of the screening gave us vital information regarding how the refugee(s) had arrived in the UK – and if they had immediate family still living in Afghanistan. This part of the screening process was by far the easiest stage.

The cultural differences and the trauma each refugee had experienced made it extremely challenging to administer the second part. For example, when asking questions regarding learning disabilities we had to first ask if they had met the developmental milestones on time; they understood learning disability to be someone struggling to read or write rather than understanding it from the aetiology perspective.

Unlike a typical screening in a clinical setting, where service users are given a time slot, we decided to have no time limit. Because of how mental health is perceived in traditional cultures, for example, once when doing a screening in one of the Afghan languages for a couple, the husband mentioned how he witnessed multiple suicide bombing incidents, which was perceived by his wife that his partner wanted to end his life rather than understanding how the term 'suicide' and 'suicide bombing' varied. We also opted to conduct the screenings with the family together in the safe space of their rooms – unless, of course, there were safeguarding concerns due to domestic violence, for example.

Challenges in a Humanitarian Crisis Service

This project has taught me how difficult it is to address this humanitarian crisis, with decisions needing to be made in a short span of time.

On reflection, perhaps over time, working in a trauma service can become addictive. I heard from many volunteers who described the narratives from their screenings and how often they become over-involved with the refugees, due to working on the project throughout weekends in addition to their day-to-day roles. Because of this, it was important that we made sure that there was no requirement for anybody to commit to particular shifts.

In terms of providing an effective and efficient service to Afghan refugees, there were a number of challenges that we faced as a team. Firstly, unlike a regular mental health service where professionals work with patients for a long period of time, we had to realise that our involvement with these people would be more temporary; the government has placed the refugees in hotels with the view to moving them to permanent housing in any part of the UK afterwards.

Moreover, as difficult as it was to build rapport with a population that has experienced trauma and are new to a foreign country, it was even more challenging to finalise a piece of work when the existing waiting list to receive specialist service in the NHS is so exhaustive. Often there was an uncertainty that these refugees may not be living in the same part of the UK by the time they reached the peak of that waiting list.

Secondly, using interpreter services was another challenge. When administering the trauma screening questionnaire, we often ran into situations where the interpreter wasn't able to translate certain terminology properly as it did not exist in their language. As a result, we had to give them scenarios in simple words rather than asking about the symptomatology. Thus, it was important to keep in mind the cultural attitudes towards psychology and how mental health is perceived, whilst having a trauma informed approach while administering the Trauma Screening Questionnaire.

While working with interpreters, we commonly faced issues such as a loss of information – or translating information that may have not even been accurate. In such circumstances as a screener, one had to take an extra step to reframe the question in order to extract the appropriate information needed.

Recommendations and takeaways

Undoubtedly, working on this project was one of the most rewarding experiences of my entire career. I have always aspired to become a neuropsychologist, and I would recommend every mental health professional to take the opportunity to work on a humanitarian crisis project.

You get the chance to hear first-hand stories of the evacuees, making you see things from a different perspective. Often the media portrays it very differently than the reality you get to experience and understand when you work with refugees.

Furthermore, it is important to have services like CAST to ensure we can set up these crucial crisis services and provide consultancy, training and research focusing on refugees and asylum seekers. The outcomes of this project undertaken by CAST has helped the Afghan evacuees to establish a health record that has captured a robust comprehensive information from their developmental milestone to their evacuation journey from Afghanistan to the UK. The screening program has also helped to liaise and provide important collateral information necessary when accessing specialist service like IAPT, dentist, occupational therapy, etc. This reduces the burden on the refugees to repeat their stories over and over again, which may be triggering when they have experienced so much trauma.

Most organisations are always on the lookout for professionals who come from a specific culture relevant to the refugees. However, I think it is extremely important to be open to recruiting a diverse group. Having a diverse workforce to serve refugees would help the multidisciplinary professional to have a deeper understanding of their culture and wellbeing when working with this population. This in turn will be helpful for refugees when it comes to adapting in the new culture because they might get dependent on the professionals that speak their language.  Currently, we are limiting our own ability to address the issue, which can further impact refugees as they seek to rebuild their lives in a new country.

The project has given me an appreciation for what it is like to set up a mental health service to support a major humanitarian crisis. There is a lot of work still to be done but here in the UK we are moving towards having an efficient system in place to tackle this challenge successfully in the future.

On a personal level, I found it easy to connect with the evacuees due to my past experiences as a child and thanks to the similarities between Afghan and Indian cultures. It is important to remember, though, that one does not have to have been a refugee to provide service to those currently facing a humanitarian crisis. All you need is to be compassionate and open to learn about their culture and belonging.

About the author

Ankita Guchait MBPsS is Assistant Psychologist, Central & Northwest London NHS Foundation Trust